| Exodontia.Info |
| Erythroplakia / Erythroplasia |
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Definition
Erythroplakia (Greek, “flat red area”) is defined as a fiery
red patch that cannot be characterised either clinically or
pathologically as any other definable lesion.
These may appear as a bright red, smooth, velvety,
granular or nodular lesions often with a well-defined
margins adjacent to normal looking mucosa and are usually
asymptomatic.
The soft palate, the floor of mouth, the ventral surface of
tongue and the retro-molar area are the most common
sites of involvement.
Erythroplakia is more common among middle aged to
elderly persons and, especially among men. It is less
common than leukoplakia.
The prevalence of these lesions range from 0.02 - 0.83%
in different regions.
Ætiology
The risk factors for erythroplakia are the same as for oral
squamous cell carcinoma.
Diagnosis
Erythroplakia is seldom multi-centric and rarely covers
extensive areas of the mouth. It is soft on palpation and
does not become indurated until an invasive carcinoma
develops in it.
It is often asymptomatic, although some patients may
complain of a sore, burning or metallic sensation.
Oral erythroplakia has the highest risk of malignant
transformation compared to all other mucosal lesions ie
Most potentially malignant of all oral mucosal lesions.
All erythroplakias should be viewed with extreme clinical
suspicion for malignancy, as they are more likely to
harbour histological foci of severe dysplasia, carcinoma in-
situ (CIS) or micro-invasive cancer.
The incidence of severe dysplasia or carcinoma in these
lesions is very high (80 – 90%) and biopsy is mandatory.
Areas of erythroplakia may also co-exist with leukoplakia
in so-called “mixed” or “speckled” lesions (erythro-
leukoplakia).
Care must be taken to obtain a representative biopsy
specimen in such cases, with sampling of multiple areas
within the lesion, as carcinoma may be present only focally.
Clinical Features
It appears as a usually asymptomatic, fiery red, well
demarcated plaque, with a smooth and velvety surface,
usually level / depressed with surrounding mucosa. The
red lesions may be associated with white spots or small
plaques.
The floor of the mouth, retro-molar area, soft palate, and
tongue are the most common sites of involvement.
Erythroplakias occurs more frequently between the ages
of 50 and 70 years.
Erythroplakia (Greek, “flat red area”) is defined as a fiery
red patch that cannot be characterised either clinically or
pathologically as any other definable lesion.
These may appear as a bright red, smooth, velvety,
granular or nodular lesions often with a well-defined
margins adjacent to normal looking mucosa and are usually
asymptomatic.
The soft palate, the floor of mouth, the ventral surface of
tongue and the retro-molar area are the most common
sites of involvement.
Erythroplakia is more common among middle aged to
elderly persons and, especially among men. It is less
common than leukoplakia.
The prevalence of these lesions range from 0.02 - 0.83%
in different regions.
Ætiology
The risk factors for erythroplakia are the same as for oral
squamous cell carcinoma.
Diagnosis
Erythroplakia is seldom multi-centric and rarely covers
extensive areas of the mouth. It is soft on palpation and
does not become indurated until an invasive carcinoma
develops in it.
It is often asymptomatic, although some patients may
complain of a sore, burning or metallic sensation.
Oral erythroplakia has the highest risk of malignant
transformation compared to all other mucosal lesions ie
Most potentially malignant of all oral mucosal lesions.
All erythroplakias should be viewed with extreme clinical
suspicion for malignancy, as they are more likely to
harbour histological foci of severe dysplasia, carcinoma in-
situ (CIS) or micro-invasive cancer.
The incidence of severe dysplasia or carcinoma in these
lesions is very high (80 – 90%) and biopsy is mandatory.
Areas of erythroplakia may also co-exist with leukoplakia
in so-called “mixed” or “speckled” lesions (erythro-
leukoplakia).
Care must be taken to obtain a representative biopsy
specimen in such cases, with sampling of multiple areas
within the lesion, as carcinoma may be present only focally.
Clinical Features
It appears as a usually asymptomatic, fiery red, well
demarcated plaque, with a smooth and velvety surface,
usually level / depressed with surrounding mucosa. The
red lesions may be associated with white spots or small
plaques.
The floor of the mouth, retro-molar area, soft palate, and
tongue are the most common sites of involvement.
Erythroplakias occurs more frequently between the ages
of 50 and 70 years.
Useful Websites:
Bond's Book of Oral Diseases, 4th Edition
CancerHelp UK
International Agency for Research on Cancer / World
Health Organisation
Useful Articles:
Dental Update 1999. Orofacial Disease. Update for the
Dental Clinical Team. 4. Red, Brown, Black & Blueish
Lesions
British Medical Journal 2000. ABC of Oral Health -
Swellings & Red, White & Pigmented Lesions
British Medical Journal 2000. ABC of Oral Health. Oral
Cancer
Journal of Dental Education 2002. Systematic Review of
Randomized Trials for the Treatment of Oral Leukoplakia
CA Cancer J Clin 2002. Oral Cancer and Pre-cancerous
Lesions
Critical Reviews in Oral Biology & Medicine 2003.
Prognosis of Oral Pre-malignant Lesions - Significance of
Clinical, Histopathological & Molecular Biological
Characteristics
J Can Dent Assoc 2004. Pigmented Lesions of the Oral
Cavity. Review, Differential Diagnosis and Case
Presentations
Oral Oncology 2004. Oral Erythroplakia - A Review
Red & Mixed Red-White Lesions. Clinical Stomatology
Conference. September 2007
ENT News 2008 - What is the Risk of a Red or White
Lesions in the Mouth Being Malignant?
MJA 2009. Clinical Update. Oral White Lesions - Pitfalls
of Diagnosis
Head Neck 2009. Treatment & Follow-up of Oral
Dysplasia - A Systematic Review & Meta-Analysis
Bond's Book of Oral Diseases, 4th Edition
CancerHelp UK
International Agency for Research on Cancer / World
Health Organisation
Useful Articles:
Dental Update 1999. Orofacial Disease. Update for the
Dental Clinical Team. 4. Red, Brown, Black & Blueish
Lesions
British Medical Journal 2000. ABC of Oral Health -
Swellings & Red, White & Pigmented Lesions
British Medical Journal 2000. ABC of Oral Health. Oral
Cancer
Journal of Dental Education 2002. Systematic Review of
Randomized Trials for the Treatment of Oral Leukoplakia
CA Cancer J Clin 2002. Oral Cancer and Pre-cancerous
Lesions
Critical Reviews in Oral Biology & Medicine 2003.
Prognosis of Oral Pre-malignant Lesions - Significance of
Clinical, Histopathological & Molecular Biological
Characteristics
J Can Dent Assoc 2004. Pigmented Lesions of the Oral
Cavity. Review, Differential Diagnosis and Case
Presentations
Oral Oncology 2004. Oral Erythroplakia - A Review
Red & Mixed Red-White Lesions. Clinical Stomatology
Conference. September 2007
ENT News 2008 - What is the Risk of a Red or White
Lesions in the Mouth Being Malignant?
MJA 2009. Clinical Update. Oral White Lesions - Pitfalls
of Diagnosis
Head Neck 2009. Treatment & Follow-up of Oral
Dysplasia - A Systematic Review & Meta-Analysis
Laboratory Tests
Histo-pathological examination.
Differential Diagnosis
The following conditions should be considered before
making a diagnosis of erythroplakia:
Management / Treatment
Management of oral erythroplakia focuses on the
prevention of malignant transformation and early
detection of occult malignancy.
Persons with erythroplakia should be advised to stop
tobacco / alcohol habits and should be encouraged to take
a diet rich in vegetables and fruits (anti-oxidants).
In view of the high malignant potential of these lesions,
the recommended treatment is surgical excision, including
laser. However, even after surgical excision, the
recurrences and development of malignancy at the same
site are high. In view of this, long-term follow-up is
essential even after surgical removal.
Histo-pathological examination.
Differential Diagnosis
The following conditions should be considered before
making a diagnosis of erythroplakia:
- Local irritation
- Early squamous cell carcinoma
- Invasive oral cancer
- Discoid lupus erythematous
- Lupus erythematosus
- Non-homogeneous leukoplakia
- Erosive lichen planus
- Acute atrophic candidiasis
- Erythematous candidiasis
- Denture induced stomatitis
- Pemphigus
- Hæmangioma
Management / Treatment
Management of oral erythroplakia focuses on the
prevention of malignant transformation and early
detection of occult malignancy.
Persons with erythroplakia should be advised to stop
tobacco / alcohol habits and should be encouraged to take
a diet rich in vegetables and fruits (anti-oxidants).
In view of the high malignant potential of these lesions,
the recommended treatment is surgical excision, including
laser. However, even after surgical excision, the
recurrences and development of malignancy at the same
site are high. In view of this, long-term follow-up is
essential even after surgical removal.
| Photos of Oral Erythroplakia |
| Last Updated 17th February 2012 |